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Seventy transtracheal aspirates (T.T.A.) have been achieved with patients having an acute pneumonia; 42 had a chronic respiratory failure; 25 had received a previous antibiotherapy; 49 presented negatives delayed hypersensitivity skin reactions. No major accident was noticed and the T.T.A. were positive in 87 p. cent of the cases. The results show the predominance of the Cocci Gram + especially pneumococcus. These cases are associated with Hemophilus influenzae in 19 p. cent of the cases. Negative skin tests show the frequency of this association. Infections with Bacilles Gram -- are found as well in this circumstance. The previous antibiotherapy alters microflora and leads to a B.G. -- as well predominance. At last, the evolution is not influenced by the discovery of an organism in the T.T.A. The authors compare the results with those found in previous work and conclude in the interest of that method which enable a quick identification of the organism and the starting of a well adapted antibiotherapy.

Adequate preparation for surgery can be achieved in patients with Grave's disease by a combination anti-thyroid medication, Lugol's solution and beta-blockers, mainly propranolol. Only in rare cases when this treatment had failed has plasmapheresis been used. No thyroid storm occurred in the 35 cases reported. Should this complication be encountered, plasmapheresis appears to be the treatment of choice.

Following orthopedic surgery of the lower limb, ten patients were given fentanyl 5 micrograms . kg-1 in a single epidural injection. Almost complete analgesia (P less than 0.001) was rapidly obtained. The total period of analgesia was rather short (182.3 +/- 32.1 min). The maximal analgesia period was 87 +/- 8.34 minutes. Despite this high dose of fentanyl (245 to 450 micrograms), in five patients the passive mobilization of the knee following surgery was extremely painful and, for that matter, impossible in three of them. Such high doses of fentanyl entail the risk of respiratory depression as respiratory rate is decreased (P less than 0.01) and the Pco2 is increased (P less than 0.01). Fentanyl should not be used at such high dosage and should probably not be preferred to morphine, considering that the duration of analgesia is short, that the analgesic score is identical to that obtained with lower doses or with longer lasting narcotics, that it does not prevent passive mobilization pains and that it entails a definite risk of respiratory depression.

A study of the key wordings used by the doctors in medical records in I.C.U. preceded this implementation, they constitute a thesaurus (2,700 strings) organized in two trees. These strings are proposed along the dialogue which occurs between the microcomputer and the user; on these bases, several graphs allow to move in the tree by minimization of the pathway. The use of the thesaurus with the corresponding graphs necessitates only one automaton program. This medical data microcomputerized system is transparent for the user, thanks to a multilayers software. In the external layer the microcomputer provides access to the system by one of the following function keys: creation of a medical record, additional information on a medical record already known, research of a medical record, listing of the open medical records, printing of a medical record. Each one of these function keys provides access to the following five rubrics keys: identity, antecedents, reasons for admission, evolution, destiny; these rubric keys use parameterized procedures. This software is implemented on a low-cost microcomputer fitted with a dual drive disk (170 k. bytes each) and a printer (90 char/s).

Ten patients with severe chronic heart failure (class III and IV of the NYHA classification) received treatment for severe heart failure with dobutamine (10, then 15 micrograms.kg-1.min-1), then with dobutamine combined with amrinone (7.5, then 10 micrograms.kg-1.min of each). Used alone, dobutamine improves cardiac performance (cardiac index from 1.8 +/- 0.24 l.min-1.m-2 to 2.65 +/- 0.44 l.min-1.m-2). These results are further improved when amrinone is associated with dobutamine. Blood pressure increases with dobutamine and no decrease is recorded when amrinone is introduced, despite a gradual decrease in systemic arterial resistances. Pulmonary artery wedge pressure shows a significant decrease only when the strongest dose of the combined drugs is used. However, this positive effect is counterbalanced by an increase in pulse frequency. Side effects, be it on the blood count (platelets count reduced from 255,600 +/- 3974 mm-3 to 207,400 +/- 3380 mm-3 with no clinic sign) or cardiovascular activity (one case of premature ventricular contraction; one case of transient junctional rhythm), do not require the suspension of treatment. Thus, the dobutamine-amrinone combination treatment seems a promising one.

About one case of necrotising enterocolitis following an extra-peritoneal and aseptic operation, it seems that a post-operative ileus, by the ischemia of mucous membrane and the swarming of anerobics that it involves, seems to be responsable of this dreadful complication. The macroscopic and deceiver aspect of intestine to an early re-operation can impeed this diagnosis. The hyperbaric oxygenotherapy seems to be a perceptible adjuvant treatment.

A 30 minute test of hyperoxia (10 l.min-1) was conducted in patients (n = 21) with chronic obstructive lung disease during the weaning trials from mechanical ventilation. Two groups were formed according to whether the occlusion pressure at 100 ms (PO.1), index of central stimulation, decreased or not during the test. The first group lowered PO.1 and increased PaCO2 by decreasing VE (minute-ventilation), VA (alveolar ventilation) and increasing the VD/VT ratio; the others had a lower PO.1 and did not modify it after administration of 02 despite a lowered PaO2 initially identical to that in the first group. They held PaCO2 constant by increasing VE and by maintaining VA in relationship with an improvement in diaphragm contractility and/or a better response to hypercapnia stimulus. All the patients is this group were successfully weaned eight days after the study period.

In cases of major sepsis the erythrocyte lipids undergo significant change especially when there is concomitant hepatic insufficiency and this in turn lead to alteration in the blood viscosity and very probably to the genesis of disorders of coagulation.

In the light of experimental studies on balloons of several intubation tubes, the concepts of occlusive pressure, tracheal pressure and minimum occlusive volume are defined and dissociated. An in vivo study made it possible to determine the importance of the tracheal mucous pulse, the suppression of which could contribute to tracheal stenosis.

The authors studied changes in erythrocyte lipids in severe infectious syndromes, separating healthy individuals (n = 10) from those with hepatic insufficiency (n = 7). No variations in sphingomyelins were seen. By contrast, the fall in cholesterol and other phospholipids studied (phosphatidylcholine and phosphatidylethanolamine) was highly significant. The difference between the two groups remained clear on the fourth day. No relationship could be established with prognosis and the organism responsible. In conclusion, the authors stress the need for study of the relationships between these changes and erythrocyte functions.

Study of changes in erythrocyte lipids after the infusion of 1,000 ml of modified fluid gelatin (Plasmion) demonstrated disturbances at the level of the lipid double layer with, in particular, a decrease in phosphatidyl-ethanolamines found in the serum. No erythrocyte deformation was seen.

The danger of the anaphylactoid reactions which occur during pediatric general anesthesia leads the authors to use a specific antihistaminic premedication. The association of cimetidine and hydroxizine has been proved to be adequate to avoid systemic histamine adverse effects and to diminish gastric secretion in pediatric anesthesia. The authors recommend oral administration.

About two cases of "Ogilvie's syndrom" so called colonic ileus or acute idiopathic dilatation of the colon, in patients with chronic bronchitis, the authors discuss the possibility of this etiology like respiratory failure. A rapid colonic decompression is necessary to prevent cecal perforation.

The authors report a case of haemorrhage due to cephalexin therapy. The bleeding started after an orthopedic operation in a patient without renal failure, receiving 3 g/day of cephalexin. Platelet function was very abnormal at the time of the haemorrhage with a bleeding time of over 20 minutes, which returned to normal when treatment was stopped. This case seems to be similar to other reports of haemorrhages during treatment with other beta-lactams.

From October 1983 to January 1985, 46 patients (38 men and 8 women; average age, 60 years; range, 37 to 83 years) underwent peripheral vascular surgery of either the internal carotid artery or the arteries of the lower limbs. Each patient had a thorough clinical examination, an ECG, and a dipyridamole-thallium-201 myocardial scan before operation. On the basis of results, they were divided into two groups: 20 patients with and 26 patients without chronic ischemic heart disease. Three major cardiac events were noted during or after a period of 1 month after surgery: There were two deaths due to cardiac ischemic events and one patient had postoperative unstable angina pectoris. These three patients were classified in the coronary group (NS). When the patients were classified on the basis of whether or not there was thallium redistribution on serial images after infusion of dipyridamole, 14 with redistribution and 32 without redistribution were noted. The three patients who had major cardiac events were in the former group (p less than 0.04). Our data suggest that patients in whom redistribution occurs have a high incidence of postoperative ischemic events. These patients should be considered for particular preoperative coronary care to avoid major postoperative cardiac events and to increase chances of survival.